Background: The incidence of type 2 diabetes (T2D) has been increasing in the pediatric population along with obesity. Depression is a known co-morbidity of T2D in both youth and adults, which is of clinical concern as depression relates to poor adherence to treatment recommendations and suboptimal self-care. The American Diabetes Association (ADA) and the American Academy of Pediatrics (AAP) guidelines recommend depression screening for youth with T2D, although implementing these guidelines in clinic can be challenging. Methods: We utilized the Define, Measure, Analyze, Improve and Control (DMAIC) methodology for quality improvement to improve the rates of documented depression screenings in youth with T2D seen in a multi-disciplinary clinic at an academic tertiary care referral center. A validated depression screening tool, CES-D, was selected and an EMR flowsheet created to improve screening rates by standardizing encounters and streamlining the process for providers and staff. A systematic chart review of individual encounters was performed and analyzed at three intervals: baseline, Cycle 1 and Cycle 2. Results: 45% of the baseline cohort lacked depression screening documentation. Following Cycle 1 implementation, 28% were not screened. Cycle 1 deficits were identified to determine root causes and possible solutions implemented. Analysis following Cycle 2 validated the improvements as only ~10% of encounters were missing depression screenings. Depression was common, with 34% of subjects screening for clinically significant depressive symptoms in Cycle 1 and 29% in Cycle 2, underscoring the importance of screening in this patient population. Conclusions: A systematic approach combining EMR tools, education, and team coordination over multiple quality improvement cycles led to continuous improvement in depression screening documentation and could be implemented at other centers. Future studies examining follow-up care of positive screens, including rates of mental health referrals, are warranted.

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